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Home My WebLink About19259-Z FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL $OUTHOLD, N.Y. 11971 TEL.: 765-180:2 ~.~amincd · ..~j...; 1' ~." 19'.. Disapproved a/c .................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS BOARD OF HEADTH .-.[~/.l:~.,e'.~.._. ~ 3 SETS OF PLANS 1~I.~72.~ ... y ' -~ ~' ~ ' SEPTIC FORM a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and Of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of properW must be drawn on the diagram which is part of th_is appli- cation. c. The work covered by th.is application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit ,hall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy .hall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of S0uthold, Suffolk County, New York, and other applicable Laws, Ordinances or ?.e,zulations, for the construction of buildings, additions or alterations, or for )emoval or demolition, as herein described· Fh¢ applicant agrees to comply with all applicable laws, ordinances, building code, housin~ code, and regulations, and to admit authorized inspectors on premises and in building for necessaryTnspections.. ............. _~, (Sign,ature o~ applicant, or name, if a corporanon) · ~z.! ..... t/. ........................... ~F ....... '-' (' (Mailing address of applicant) "~ ' ~;tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .,:,mc of owner of premises . ."./.u ,,/. ~-'~-~',.~¢--~.! ~'. ot~:Z-.t~.,.-..~.:'. :'. .... /.,~.~,-r .-r..-z. ~-:~.d//..~'O..--: .............. (as on the tax roll or latest deed) !:' .:pplicant is a corporation, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ........................... Plumber's License No .... /8/.~.. :'./~ ........ Electrician's License No... L .9..~..f ........... Other Trade's License No '-- '"'. ............... lq~c) ~.x~ ~ ~ ~ Location of land on which proposed work will be done .... ~4...~ ,f~ ~ ~ , ............... House Number Street ~amlet ~' " bdlvlslon.. ~,~,~ L~,ff~ ............... .... Su '''~ /_(Nan, e)~ State ~xisting use and occupancy of~jemiscs and intended usc and occupancy of proposed construction: b.a' Intended E,iating use u,eand and occupancy occupancy .... ):: ~4~ ~g' ; ~~23; ................. '" ~ d f~ -"~':-'/:t.'"' ~' ~ .......... ~' ..... 3. Nature of work (check which applicable): New Building .......... ~ Addition .......... Alteration .......... Repair .............. Removal .............. Demolition .............. Other Work ............... (Description) 4. Estimatdd Cost.. ~..~..3(. ~....~,.a. oA ~..~.. L/Y.~-J~-.a~..oo... Fee ...................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units . .,,-~ .q. ......... Number of dwelling units on each floor If garage, number of cars ...: .: .................................................... .............. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of nsc .... ~ ................ 7. Dimensions of existing structures, if any: Front ...... ~ ...... Rear ..... .--7'. .......Depth..TVA. .......... Height ....... ~ ...... Number of Stories Dimensions of same structure with alterations or additions: Front ...... . .--'Z. ........ Rear -- Depth ........ .'7. ............ Height ......... .-':.., .......... Number of Stories....--~--. .... ,.' ' ~ ...... 8. Dimensions of entire new construction: Front .'~ ~ a" Rear ',~ ,,.~7~.-'o n,,~,h ~3' ~:--' ~" ...... Height ............... Number of Stories . ./. :~ . / ~. / ,, 9. S~ze of lot: Front d2~'~.(...7.5..'-%0 ........ Rear..fd~.. f~-f-7.O. ....... n~h /~,'~¢-" ;~. '~ ~ - d 10. Date of Purchase ...0.. f/.~..././.. :~0 ........... ...,N~an4~ of Former Owner .~4~.~..~'~'~'.~ 11. Zone or use district in which premises are situated...~/./). ................ ~. .............. 12. Does proposed construction violate ma~zoning law, ordinance or regulation: ~ ...................... 13. Will lot be regraded . ,,.-"~[/..~.~ ~,~ ....... ..... Will exc~s filJ be, remoyed from premises: Ye~ f No) 14. Name of Owner of pnre~mi.se_~,~0?~3.0.g~./.t~ L0-gaagat/... Address ,~,f..-~af~A;(7. f/.~.g~4.~f. Phone No. ~.5.-[-~..~'I/ Name of Architect (.~L,'~v.2,~,~(~/~, .t~. ..... Address~,~-/~--fi.,~..~..~/-~~ Phone No 9,~'~-:' g'~/'(~' ' · ,9~ --~ ~ ,'';''' ~' -" ...... d ...... :' ................. Name of Contracto~'~}¢7~. ,t~f.~.. :4~/J~.e., f.~.V.d.... Address ~,g~'d~flf.~.~... Phone No..c~. ~.~../.~.57.~,.. IS.Is this property located within 300 feet of a tidal ~etland? *YP-S .... *If yes, Southold Town Trustees Permit may be required. PLOT DIAGRAM Locate clearly and distinctly ~11 buildings, whether existing or proposed, and. indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or comer lot. i '~ ST'~ T~O F NEW YORK ' I COU,"JTY OF ~..U~_i~ol J,, $.S j ......... (Name of individual signing contract) ~bov~ named. ..... .... .......... ' ................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ~d is duly authorized to perform or have perfo~ed the said work and to m~e and file this application; that all statements contained M this application are true to the best of his knowledge and belief; and that ~he work will be performed in the m~ner set forth in the application filed therewith. Sworn to before me this · ~ Public .... ~ ~g .... ~ .... County ~ ~,$~~ ................................... ~ ~ ~ ~ (Signature of applic~t) L°T 10" E L°T FF£ \ _-- AVi~NUI~ .______~- - NoTON wASHI AREA = 20,592 sq. ft. SURVEY OF LO T 3O SUBDI VISION oF GL=DARFIEI DS FILED JUNE *27, 1990 FILE NO. 9~9 A T GREENPOR T r~.~..~-,..~.-., TOWN OF SOUTHOLD · '"-~'"~-~"'-0~',,..,._..,,._,._~.,~, SUFFOLK COUNTY, N. Y. ~""'"'°'""~~ 1000 - 40 05 -P/O Ol Scale ~" = 30' July 11, 1990 ~~__~~~.__~ , July ~und. loc.) (/% LOT ~ LOT (~' 7S' 58' 10" E LOT ~ WASHI AREA = 20,592 sq. ft. OAliO~ ROXANNE MAUNAUSKAS SURVEY OF L.O T 30 SUBDIVISIOI~ OF CEDARFIELDS FILED JUNE '27, I~0 FILE NO. ~8 A T GREENPOR T TOWN OF SOUTHOLD SUFFOLK COUNTY, .N. Scale " July 11, 1990 . July 30; 1990(foond. loc.) P. O. BOX ~09 I 86- 521(30)